Provider Demographics
NPI:1063601623
Name:DPMSCOLLPRPA LLC
Entity type:Organization
Organization Name:DPMSCOLLPRPA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:
Authorized Official - Last Name:SCOLL
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:215-206-0297
Mailing Address - Street 1:2375 WOODWARD ST STE 111N
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19115-5120
Mailing Address - Country:US
Mailing Address - Phone:215-676-7080
Mailing Address - Fax:215-676-7802
Practice Address - Street 1:2375 WOODWARD ST STE 111N
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19115-5120
Practice Address - Country:US
Practice Address - Phone:215-676-7080
Practice Address - Fax:215-676-7802
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-19
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC004133L213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA118004Medicare PIN
PA6110540001Medicare NSC
PAU60928Medicare UPIN